Hand, Foot, and Mouth Disease Update: A Conversation with Elizabeth Swanson, MD

"I joked early on in my practice that I never saw hand, foot and mouth disease because pediatricians were on top of it...and then, about 7 to 8 years ago, everything changed," Elizabeth Swanson, MD, said in a discussion with Patient Care Online^©.

At the 2025 American Academy of Dermatology (AAD) annual meeting, dermatologist Elizabeth Swanson, MD, discussed significant developments about hand, foot, and mouth disease (HFMD)—a condition that has evolved significantly over the last several years. While HFMD was once a routine pediatric diagnosis primarily managed by pediatricians, Dr Swanson noted the emergence of coxsackievirus A6 as the dominant cause, presenting with unique and sometimes severe manifestations.

Unlike the traditional culprits, enterovirus 71 and coxsackievirus A16, coxsackievirus A6 can affect adults and teenagers. This strain often manifests with distinct features, including a severe rash in the diaper or underwear region, a departure from previous viral presentations. It is also associated with onychomadesis and the development of eczema coxsackium, a severe rash that merges eczematous and HFMD characteristics.

With these evolving presentations, primary care clinicians play a crucial role in diagnosing and managing HFMD, particularly in atypical cases that extend beyond children. Above, Dr Swanson shares insights on how to identify and manage these cases in clinical practice.

Swanson, of St. Luke's Children's Hospital in Boise, Idaho, is board certified in both dermatology and pediatric dermatology, She is a past president of the Colorado Dermatologic Society, and a frequent lecturer at conferences such as AAD, discussing pediatric dermatology with clinical audiences from all across the country.

For more of our conversation with Dr Swanson, check out When HSV Causes Big Dermatologic Problems

For more 2025 AAD Meeting coverage, please click here.